Tracing people living with HIV who are lost to follow-up at ART programs in Southern Africa: A sampling-based cohort study in six countries.

Ballif, Marie; Christ, Benedikt; Anderegg, Nanina; Chammartin, Frédérique; Muhairwe, Josephine; Jefferys, Laura; Hector, Jonas; van Dijk, Janneke; Vinikoor, Michael J; van Lettow, Monique; Chimbetete, Cleophas; Phiri, Sam J; Onoya, Dorina; Fox, Matthew P; Egger, Matthias (2022). Tracing people living with HIV who are lost to follow-up at ART programs in Southern Africa: A sampling-based cohort study in six countries. Clinical infectious diseases, 74(2), pp. 171-179. The University of Chicago Press 10.1093/cid/ciab428

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BACKGROUND

Attrition threatens the success of antiretroviral therapy (ART). In this cohort study, we examined outcomes of people living with HIV (PLHIV) lost to follow-up (LTFU) 2014-2017 at ART programs in Southern Africa.

METHODS

We confirmed LTFU (missed appointment for ≥60 or ≥90 days, according to local guidelines) by checking medical records and used a standardized protocol to trace a weighted random sample of PLHIV who were LTFU in eight ART programs in Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe, 2017-2019. We ascertained vital status and identified predictors of mortality using logistic regression, adjusted for sex, age, time on ART, time since LTFU, travel time, and urban or rural setting.

RESULTS

Among 3,256 PLHIV, 385 (12%) were wrongly categorized as LTFU and 577 (17%) had missing contact details. We traced 2,294 PLHIV (71%) by phone calls, home visits or both: 768 (34% of 2,294) were alive and in care, including 385 (17%) silent transfers to another clinic; 528 (23%) were alive without care or unknown care; 252 (11%) had died. Overall, the status of 1,323 (41% of 3,256) PLHIV remained unknown. Mortality was higher in men than women, higher in children than in young people or adults, higher in PLHIV who had been on ART <1 year or lost >1 year, living further from the clinic or in rural areas. Results were heterogeneous across sites.

CONCLUSIONS

Our study highlights the urgent need for better medical record systems at HIV clinics and rapid tracing of PLHIV who are LTFU.

Interest & Impact

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